"...Bringing Light To The Darknesss"

Rocky Cagle, RN and Go Team member

We arrive to the university hospital around 7:15 a.m. We have a short debriefing and then off to our units. There is no way to know what we are in for each day. I meet with my interpreter and we chat about our previous night. I ask about his family, how his wife and kids are and he always says they are good. It's hard for me to comprehend they are "good" with their home destroyed and having to live in a small tent that is meant for two- but accommodating five. He says his kids love not going to school.

I think to myself that perhaps they have not yet realized that their schools are destroyed and the devastation of the earthquake has taken the lives of their classmates and teachers. After the brief conversation we are ready for our day, both of us knowing it's going to be long and hot.

We don't give the conditions a second thought as we are immediately focused on making a difference -- bringing light to the darkness that surrounds so many here.

Arriving on the unit I take inventory to see what supplies we have for the day. I have learned that many of our supplies are missing. Already patients are waiting for care. The long lines twist
down the street. American care is here and the Haitians have welcomed it with open arms. They have a robust confidence in the work we do -- often expecting a cure for the incurable.

As the chaos begins, there are doctors and nurse swarming the tents. Novice nurses work side-by-side the seasoned health care providers. The newest additions to our ER flounder briefly asking questions like, "Where is this antibiotic? Where is this narcotic? Will you start this IV? Can you figure out what is wrong with patient.? I am new here can you help with what I should do?"
The intensity drives all of us to push our limits and immediately adjust to the demands from all sides. After 10 hours of craziness in 100 degree heat, we finally come to a day's end and take time to reflect on the day.

Have made the right calls? Have we truly done out best to make a difference. The realization that our Hopkins group will have worked over 1,000 hours within 10 days, does not ease the demands I have for myself and the short-comings I have identified within myself. It's two weeks
out of my life -- a short time to do the good I set out to do.

Pierre, my translator has stood by my side all day. He's held my supplies at my side, tidied my workspace, and spoken every one of my words. He comes here every day to make a difference of his own. Knowing his family awaits him, he sets off back to his "home."

Despite leaving the ER for the evening, my mind is continuously rewinding through the day. How will I be better tomorrow? Am I good enough for these people who depend on us so much? I think of each face of each patient, each heart I have touched. The strain and stress can be overwhelming but I find a strength in those who depend on me. I will return tomorrow with a smile on my face, a soothing touch to my medicine, and shoulders to carry the burden of a broken country.

"I Don't Know How People Are Surviving Here..."

Alicia Hernandez
Emergency RN and Go Team member

Day 6 in Port-au-Prince: Half-way through our stint here. I can't believe it was only one week ago that we were first flying here. It feels like so many more. I hit a brick wall yesterday as we have all been working almost non-stop since arrival. Some since the minute we stepped off the bus from the Dominican Republic into the hospital. It's the long hard hours in the sweltering heat of the tent, the relentless flow of patients desperate for miracles we can't provide, the lack of sleep, and continuous failed efforts to stay hydrated and nourished. At least one volunteer has succumbed to the pressures everyday since we've been here, to the point of being unable to walk and needing IV hydration.

I came dangerously close to that point multiple times about every 2 hours yesterday, needing to find shade outside of the tents, and force down some oral re-hydration salts (ORS).
I had at least 3 liters of ORS plus more water and still couldn't last more than 2 hours in the tent without feeling like I was going to vomit and pass out. I realized I had to take more than the time it took to down a liter of ORS away from this work. Thankfully everyone else realized it yesterday as well and time off is now not only being more welcomed, but mandated. I quickly stepped up to the plate to take the first day off. I finally slept better, I think knowing I wouldn't face the pressures of not only caring for others this morning but caring for myself in this condition.
That alone was a huge weight lifted for the night. And I still awoke nauseous and still feel so now. But I'll get through. All of us are (with a few exceptions of early flights home for fear of serious illness). With being awake through the night not only because of the heat and stress and mosquitoes, but because of having multiple trips to the bathroom with vomiting and diarrhea. The bonus of doing medical relief is that we all have easy access to medicines and IV fluids with the know-how to provide it to each other. I started an IV on another nurse that went down in the middle of the day yesterday. I have been offered IV fluids and Zofran and cipro by many of my fellow volunteers.
Everyone cares and everyone understands. It's great camaraderie and great inspiration to see what we are all going through to try and make some difference here. And I like to believe it's in the small ways that we are. We are so limited in what we can do for the severely sick and without Social Work, it feels so wrong to discharge those without a home to go to but that is nearly everyone. I don't know how these people are surviving but they are. Not only that, but they smile and thank for the simplest things - some Tylenol, a little cleaning and fresh gauze on a horrendous wound that covers half their leg that they have to limp out on. And to where?
A two-tarp tent, waiting for the next food and water drop. We pass by their lives,
sheltered by the walls of the bus and the walls of hospital, see them cooking and bathing on the sidewalks, bustling to and fro. Life goes on in unexpected ways.

"We lose one staff a day..."

Tom Kirsch, M.D. (pictured right) with Rocky Cagle, RN

Tom Kirsch, M.D.
Johns Hopkins Emergency Physician and Go Team Leader

The day starts about 5:30 a.m. when the hotel turns back on the power. The fans come back on at least. People begin stirring, snores fade away,
backpacks rustle and feet pad around.
The lights usually burst on at six and then the activity intensifies except for a few trying to squeeze out a few more minutes of sleep. People dress, food and supplies are gathered.
The bus leaves at 7 a.m., driving less than a mile past normal buildings and lives and crumbled ones and tent camps. Vendors have already lined the streets
past the ramshackle tents in the city’s main plaza- food stalls, haircuts, a Gno Kozes (snow cones), but most interestingly the guy with the truck. It is well lit
by fluorescent lights and has a rack of blenders in the back making smoothies.
At the gate of the hospital there is already a half-block long line of patients waiting to get in.
By 7:15 a.m. we have completed out briefing and are pulling supplies.
The little triage tent is bursting with people.
A report is given by the night team- there are always leftovers – usually very sick. They bring the sick ones from the rest of the compound back to the ED if they go bad at night, and only the really sick come in after midnight.
Patients start pouring in.
Our tents are hot, probably 10-20 F hotter that the ambient 95 F air outside. They have few windows and the power only runs occasionally to run the
fans.
We loose at least one staff a day to heat exhaustion.
Yesterday it was the 6’2” nurse from Utah. Dizzy and pale, then down and vomiting.
We run IV fluids and bring them to a cooler area. We have started mandatory fluid requirements, and push people to take breaks and now will have a
mandatory ½ day off every 5 days minimum.
The army guys might hook us up to one of their generators so we can at least run the fans. I got pizzas and cold Cokes delivered from the outside yesterday. A strange comforting little piece of normality.
The buses head back between 5:30 and 6 and it is always a scramble to tuck things away, restock and sign out to the night people. We usually miss the
bus and bet the late one.Debriefing 6-6:30 or 6:45 (although I usually miss the first few minutes, preferring to sit with my sore feet dangling in the cold pool water and drinking a
beer). Dinner cafeteria style is at 8. Most people start fading out around 9. The few hardy (stupid? gregarious? Insomniacs?) sit on the patio late
talking and drinking $4 beers or soda until late surrounded by the reporters furiously working on stories and hogging all the wireless bandwidth).Finally sleep in the dark conference room with 40-50 people scattered around in various odd sleeping arrangements- bed mattresses, inflatable ones,
cots, even tents pitched indoors. The stirring, rustling backpack and padding feet gradually fade away and a low-grade background hum of stores rise up
and the day ends.

"They lost their house..."

Rocky Cagle, R.N.

Go Team member and ICU nurse

Today was a good day. We saw a good bit of patients today. As some of you may not know I am now in the ER because they needed more help there. The whole Johns Hopkins crew runs the ER. All 8 of us.

It is better than staffing the ICU because there is nothing I could do for those people. I am charge nurse of the ER so it is good to be running the show and having people look up to me. (Cagle in middle of photo left)
My Creole interpreter has a wife and three kids. They lost their house in the quake and his brother died. He had 5 U.S. dollars for the past two days to buy food for his family. He gets paid $20 a day but has not been paid them since last Friday, 9 days ago. They live in the tent village about 15 miles away. He has to take a cab to work every day which costs money. I got some MREs for him and his family today. His wife is washing my clothes for some money. I gave him $10 for him and his family. He said "How - I don't know how - I will ever repay you!"I plainly stated I couldn't do anything without him; he owes me nothing. I plan on giving him everything I have left if anything when I leave here. We were walking around today, and he decides to tell me a joke and his broken English, "as we walk here let me tell you joke, Jesus and Peter were hanging out. They were about to go on a walk but before Jesus told peter to make them a chicken. Just a chicken with nothing else to eat before their walk.Peter said OK and proceeded to make the chicken. When the chicken came out it only had one foot. Jesus said Peter what happened to the chicken's foot?

Peter said all chicken only have one foot. Jesus said Peter my Father made chickens and I know they have two feet. Peter said no they all have one foot.Jesus said well OK, and they went on the walk. Right outside is a chicken standing on one foot. Peter said look Jesus one foot, Jesus looked and scared the chicken and it ran off, with two feet.Peter said Jesus you always make miracles!It was funny and heartwarming.

Other than that we are dealing with patient that have dengue, HIV,tuberculosis, malaria, a lot of sores, gunshot wounds, etc.

"Saw some amazing cases..."

Gene Gincherman, M.D.
Go Team member and Johns Hopkins Suburban Hospital emergency doctor

Today I worked a day shift again, but took on a different role and became an ER flow manager, making sure that the patient flow got more efficient.

I was running around all day distributing patients between different docs, communicating with managers, teams from other NGOs, pharmacy, lab, etc. It was also important to make sure that none of the providers got dehydrated, and had their 15 minutes to swallow an MRE, and stay hydrated.

Tom Kirsh, M.D. (Go Team leader) took on the role of disposition manager, making sure that patients were moved out ofthe ER efficiently. I thinks all of the docs liked the system that Tom and I put in place today much better.
Unlike other days, not a single patient left without being seen. The volume was lower oday, only about 160 patients (it is Sunday in Haiti, and people are very religious). I suspect tomorrow I will have to manage the flow of 300-400, which may be more challenging.

I have a feeling I am now appointed to be the operational manager for the rest of the stay. Still saw some amazing cases: tetanus, possible cerbral malaria, saved a guy with a gunshot wound to the back,and another with a stab to the groin, that got his femoral artery.
I have become good friends with the medics from 82nd Airborne. They are great guys, and are very helpful.
One of them said something truly meaningful to me: "Don't let anyone ever tell you that you are nor making difference, no matter how frustrating it gets at times".
That meant a lot coming from a guy who's been to place that we as civilians can only fathom.

"He died two hours later."

Tom Kirsch, M.D.
Johns Hopkins emergency physician and Go Team leader

We work out of big, cream-colored tents, maybe 30 feet long and 15 feet wide. There are tents scattered all over the compound, from many different countries, but all with slight variations on the same design and a color range of white to tan. I guess they are the international standard disaster tent.

We have three tents for our ‘Triage Emergency Department’. Two tents stand out: the ‘Jiffy Pop’ (look that up those of you born into the microwave era), and the Blue Tent.

The Blue Tent is the infectious disease tent with six places for the emaciated people coughing blood that we think have advanced TB. There is an exceptionally brave and unassuming Infectious Disease fellow from California who works there, pretty much alone it seems. She is quiet and unassuming with dark hair and a serious look about her. And she risks her health and maybe even life every time she steps in there.

She works 10-11 hour shifts. At night the patients are alone to cough and gasp for breath, The patient I sent there yesterday was a 19-year old with what appeared to be advanced AIDS. He looked like one of those classic ‘refugees’ in a starvation area with racks of ribs cascading down his chest, sunken eyes and limp, lean arms and legs. By the time he got to us he was already breathing so hard that he had to sit upright and could only gasp out one or two word sentences. He was sweating and you could see every muscle in his torso working to drag in each breath.

We poured antibiotics, anti-malarials and fluids into him immediately, but because he reported coughing blood we moved him to our ‘isolation area’- the open space between our two tents under the shade of some trees. I moved his to the Blue Tent in the late afternoon knowing there was not much to do, but hoping the California doc could work some miracle.

The next morning I went by and was somewhat surprised to see him from under the tent flap still sitting in his bed. After donning an N-95 mask I went into to the dark cramped tent among the shrunken, slightly stirring bodies to get a better look. He sat exhausted and glassy-eyed, sweat streaming off of him and making small grunts with each breath. It took him all his remaining strength to keep himself breathing thru the night and now he had no reserves left. I just tuned and left.

He died two hours later.

"Heartbreaking to see..."

Today was another day in Haiti - hot. I work in the ER now because there are great needs there. The Johns Hopkins crew is pretty much running the ER now with good outcomes.

We saw 470 patients today (triage at University Hospital in picture at left); others walked away. There is a lot of continuity of care and we work together well. We see cases from tuburculosis, malaria, typhoid, tetanus gun shot wounds, motor vehicle accidents, CHF, etc. We are good at diagnosing these cases but there is a problem with medications; they are hard to come by.

We could save most of these patients with good facicilities and meds. It's heartbreaking to see people that we know are going to die without treatment that we can't perform. Ten more days to make a difference in these peoples lives. If I only make one difference in one life, it will be worth this effort. - Rocky Cagle, Hopkins ICU RN.